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Attention Control a Focus at Bombardier Safety Standdown

Human Factors | November 27, 2014

Author: Brent Fishlock Technical Advisor Brent Fishlock shares an observation from this year’s Bombardier Safety Standdown in Wichita, Kansas.

Bombardier and the presenters at this year’s Safety Standdown shared many great stories about the importance of maintaining one’s attention through Attention Control Techniques, or ACT. The following is just one example.

During the manufacturing process, serial numbers are etched onto aircraft parts, including the front fan of the engine (commonly referred to as the N1 fan). The device that creates these markings is specific to the job and must be used properly.

A Bombardier regional jet was flying in the cruise portion of its flight when the entire N1 fan departed the engine, resulting in an uncontained engine failure. Luckily, the aircraft landed safely and no one was injured. It was discovered that the etching process had been carried out incorrectly, and with the wrong etch marking device. Many N1 fans had been etched improperly, and were in fact mounted on engines and in use. These fans were removed.

Systems are designed and procedures are written so that processes create the desired results. We as maintainers, pilots, and support staff must receive the training we require, but then we must take ownership of that training and follow the procedures we have learned to the letter to produce the desired outcome. Systems design, covered in’s Human Factors lessons, includes task analysis, whereby a task is identified by its start point, end point or goal, required intermediary steps, and required resources. Task analysis will not generate the desired outcome if the operator does not follow the training or use the resources provided.

At the Standdown, Tony Kern spoke of the science of deliberate focus, where we must practice a craft properly in order to improve. Are you using the correct tool in the correct way? Do you start at the beginning of the checklist again if you are interrupted? Do you let the altitude alerter remind you that there is 1000 feet to go to level off, or do you make the call before the aircraft does? Are you monitoring actively or passively? Are you paying attention?

Follow your training and centre your attention on the task at hand in order to become proficient and generate the desired outcome.

Brent Fishlock is a technical advisor for Currently an airline pilot, he also has an extensive background in corporate aviation.

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